RESUMO
BACKGROUND: The role of laparoscopy in the repair of incarcerated incisional or ventral hernia is not yet established. This presentation reviews the authors' experience with patients who underwent laparoscopic surgery in presence of incarceration. METHODS: Patients who had surgery during the years 1997 to 2001 were included in the study. All patients underwent surgery immediately after their admission. In all cases, Gore-Tex Dual Mesh was used. RESULTS: The review included 25 patients (21 women and 4 men). Ten of these patients (40%) had undergone at least one earlier repair, and one patient (4%) underwent conversion to open repair because of small bowel injury. The mean operation time was 63 min (range, 15-20 min). The median postoperative hospital stay was 3.2 days (range, 2-7 days). There were no noteworthy postoperative complications. During the follow-up period, no patient experienced recurrent hernia. CONCLUSIONS: The authors' current has experience demonstrated that laparoscopic repair is feasible and can be attempted for patients presenting with incarcerated incisional or ventral hernia.
Assuntos
Hérnia Ventral/cirurgia , Laparoscopia , Adulto , Idoso , Idoso de 80 Anos ou mais , Tratamento de Emergência , Feminino , Hérnia Ventral/complicações , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: The repair of a subxyphoid hernia is a difficult procedure that nonetheless results in a high rate of recurrence. The laparoscopic approach is a promising new technique for more efficacious treatment of this condition. This is the first report in the English-language literature to describe the use of this approach for the correction of poststernotomy subxiphoideal hernia. METHODS: Information was retrieved from the patients' hospitalization and outpatient clinic files. Of 984 patients who had a median sternotomy, 10 developed a substernal subxiphoid epigastric hernia. These patients had all been treated laparoscopically using Gore-Tex mesh. RESULTS: Nine patients were admitted electively and one urgently. The fascial defect sizes were 4-15 cm (mean, 8.5) in length. Intraabdominal content was adherent to the hernia in six patients; in the other four cases, the defect was adhesion free. In four patients, an incidental surgical procedure was performed (three cholecystectomies and one inguinal hernia repair using the trans abdominal preperitoneal [TAPP] technique). The operations lasted 25-120 min (average, 55). No death occurred as a result of the operations, and none of the operations was converted to an open procedure. Three patients had minor postoperative complications. During 20-42 months of follow-up, one patient suffered a recurrence. CONCLUSIONS: Laparoscopic repair of a poststernotomy subxiphoideal epigastric hernia is feasible and has a low rate of minor complications. Our review of the literature indicates that this technique produces a better outcome than the conventional open repair.
Assuntos
Hérnia Hiatal/cirurgia , Laparoscopia/métodos , Esterno/cirurgia , Idoso , Idoso de 80 Anos ou mais , Ponte de Artéria Coronária/efeitos adversos , Seguimentos , Hérnia Hiatal/etiologia , Humanos , Tempo de Internação , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Telas CirúrgicasRESUMO
BACKGROUND: Revision of gastric bariatric operations is sometimes technically difficult and may fail to achieve prolonged weight reduction. The use of the adjustable silicone gastric banding (ASGB) offers a new approach for these revisions. METHODS: ASGB was performed as a revisional procedure on 37 patients whose initial bariatric operations were as follows: silastic ring vertical gastroplasty (21), gastric bypass (12), horizontal gastroplasty (3) and vertical banded gastroplasty (1). RESULTS: The length of the procedure varied from 55 to 145 minutes (mean 83 minutes). Intraoperative complications included two fundic tears which were sutured without any postoperative sequelae. Five patients needed reoperation during the first postoperative year due to gastric volvulus (1), tubing tear (1) and development of postoperative ventral hernia (3). BMI fell from 44.8+/-SD 8.07 to 33.4+/-6.9 kg/m2 for patients operated with BMI higher than 35 kg/m2 and from 29.2+/-3.32 to 25.4+/-2.8 kg/m2 for patients operated with BMI lower than 35 kg/m2. CONCLUSIONS: ASBG can be performed with revisions with an acceptable complication rate and postoperative weight reduction.
Assuntos
Gastroplastia/instrumentação , Obesidade Mórbida/cirurgia , Reoperação/instrumentação , Silicones , Adolescente , Adulto , Idoso , Índice de Massa Corporal , Falha de Equipamento , Gastroplastia/efeitos adversos , Gastroplastia/métodos , Gastroplastia/psicologia , Hérnia Ventral/etiologia , Hérnia Ventral/cirurgia , Humanos , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Obesidade Mórbida/diagnóstico , Satisfação do Paciente , Atelectasia Pulmonar/etiologia , Reoperação/efeitos adversos , Reoperação/métodos , Reoperação/psicologia , Estudos Retrospectivos , Volvo Gástrico/etiologia , Volvo Gástrico/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Inquéritos e Questionários , Técnicas de Sutura , Fatores de Tempo , Falha de Tratamento , Redução de PesoRESUMO
BACKGROUND: The incision length has significant influence on the postoperative course after silastic ring vertical gastroplasty (SRVG). METHODS: A technique is described in which SRVG can be performed through a minilaparotomy incision. RESULTS: 110 patients were operated with this technique during 1996. No remarkable intraoperative or postoperative complications were encountered. Postoperative weight loss has been satisfactory. CONCLUSIONS: Performance of SRVG through a minilaparotomy is feasible. The technique is recommended for surgeons familiar with the operation through the formal incision.
Assuntos
Gastroplastia/métodos , Laparotomia , Adulto , Índice de Massa Corporal , Materiais Revestidos Biocompatíveis , Dimetilpolisiloxanos , Estudos de Viabilidade , Humanos , Silicones , Fatores de TempoRESUMO
BACKGROUND: Diaphragmatic rupture is one of the most commonly missed injuries in trauma cases. Traditionally, laparotomy or thoracotomy has been the treatment of choice for this condition. METHODS: During the last 2 years, we treated three patients laparoscopically to address neglected diaphragmatic ruptures that caused herniation of the intraabdominal contents. RESULTS: In all three cases, laparoscopy succeeded in identifying the diaphragmatic defect, so that the herniated viscera could be released and the defect repaired primarily or with a prosthesis. The intraoperative and the postoperative courses were uneventful; there were no significant complications. CONCLUSION: Laparoscopy has an important role in the surgical treatment of missed diaphragmatic ruptures.
Assuntos
Diafragma/lesões , Hérnia Diafragmática Traumática/diagnóstico , Hérnia Diafragmática Traumática/cirurgia , Laparoscopia/métodos , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Ruptura/diagnóstico , Ruptura/cirurgia , Telas Cirúrgicas , Resultado do TratamentoRESUMO
We describe the case of a young and otherwise healthy nurse who developed pseudomembranous colitis ten days after receiving oral clindamycin for dental infection. Her clinical course was particularly stormy and was characterized by severe diarrhea and vomiting, profuse ascites, pleural effusion, abdominal tenderness, peritoneal irritation, and systemic toxicity. The Clostridium difficile assay was negative on two occasions. Features compatible with pseudomembranous colitis were seen at sigmoidoscopy, and the diagnosis was confirmed by biopsies.
Assuntos
Enterocolite Pseudomembranosa/diagnóstico , Adulto , Antibacterianos/efeitos adversos , Biópsia , Clindamicina/efeitos adversos , Clostridioides difficile/isolamento & purificação , Infecção Hospitalar , Diagnóstico Diferencial , Enterocolite Pseudomembranosa/induzido quimicamente , Enterocolite Pseudomembranosa/microbiologia , Feminino , Humanos , Enfermeiras e Enfermeiros , SigmoidoscopiaRESUMO
BACKGROUND: Morbid obesity and malnutrition have both been demonstrated to have deleterious effects on the immune function. Cytokines are immunomodulatory peptides that have profound effects on immune function. To the authors' knowledge, the effect of surgically induced weight reduction on the cytokine levels has yet not been studied. In the present study, the authors determined the effect of surgically induced weight reduction on the levels of the cytokines interleukin-3 (IL-3) and tumor necrosis factor-alpha (TNF-alpha). METHODS: 14 patients undergoing silicone ring vertical gastroplasty were included in the study (mean BMI 48.85 kg/m2; range 38.1-52.0 kg/m2). Determination of the IL-3 and TNF-alpha levels was performed preoperatively and 14 days and 6 months postoperatively, when all patients had lost 25% to 30% of their preoperative weight. RESULTS: The IL-3 values before the procedure, and 14 days and 6 months after, were as follows: 9.69 +/- 1.82, 9.36 +/- 1.28, and 8.42 +/- 1.26 pg/mL, respectively (P < 0.05 preoperative versus 6 months postoperative level). The preoperative TNF-alpha levels showed a wide distribution. For this reason, the patients were divided into two groups: Group A with preoperative values >10 pg/mL and Group B with values <10 pg/mL. In Group A, a significant decrease from the preoperative level of 24.46 +/- 6.83 to 7.59 +/- 4.56, and 6.69 +/- 5.46 pg/mL was measured at 14 days and 6 months postoperatively, respectively (P < 0.05). In Group B, the TNF-alpha levels were not significantly changed and were 5.45 +/- 2.26, 7.59 +/- 4.56, and 8.82 < or = 6.27 pg/mL, respectively. CONCLUSION: The present study demonstrates a significant decrease in the levels of the cytokines, IL-3 and TNF-alpha. These changes can be responsible for alteration of the immune function after surgically induced weight reduction.
Assuntos
Gastroplastia , Interleucina-3/sangue , Obesidade Mórbida/sangue , Fator de Necrose Tumoral alfa/análise , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Obesidade Mórbida/cirurgia , Redução de PesoRESUMO
BACKGROUND: Laparoscopic repair is a new alternative approach to postoperation ventral hernia (POVH). Whether this procedure is accompanied with acceptable operation risk and recurrence rate is not yet established. METHODS: During 1996, we performed laparoscopic repair of POVH in 53 patients. Twenty-nine (55%) of these patients had a history of at least one failed hernia repair. The size of the abdominal wall defect varied from 4 x 5 cm to 15 x 20 cm (median, 13 x 9 cm). All operations were performed with the patient under general anesthesia. In all cases, the Gore-Tex(R) Dual Mesh (W. L. Gore & Associates, Flagstaff, AZ, USA) was used in sizes varying from 5 x 7 cm to 20 x 30 cm (median, 15 x 12 cm). RESULTS: No deaths occurred as a result of the operations. Intraoperative small bowel injury occurred in two patients (3.6%), which necessitated conversion to laparotomy and performance of small bowel resection in one case and simple suture in the other. Small bowel obstruction developed during the immediate postoperation period in two patients (3.6%). In one of these patients, laparoscopic lysis of adhesions had to be performed. Graft infection with subsequent graft removal occurred in one patient (1.8%), and abdominal wall hematoma developed in another patient (1.8%). Length of hospital stay varied from 2 to 8 days (median, 3.3 days). Follow-up period ranged from 10 to 22 months (median, 17 months). During this period, recurrence of hernia occurred only in one patient in which the mesh had been removed. CONCLUSIONS: Laparoscopic repair of POVH is technically feasible. According to our experience, it is the preferred method for patients who have had an earlier failed open repair and patients in whom it is the first repair. Cases with a high likelihood for small bowel injury must be recognized and converted to routine open repair.
Assuntos
Hérnia Ventral/cirurgia , Laparoscopia , Adulto , Idoso , Idoso de 80 Anos ou mais , Hérnia Ventral/etiologia , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Recidiva , Telas CirúrgicasRESUMO
We describe our experience in 14 patients operated on for small bowel obstruction, who underwent laparoscopic adhesiolysis. In 13 (93%) the obstruction was relieved and only 1 case required conversion to open operation. Bowel activity usually resumed within 24-48 hours, and there were no remarkable intraoperative and postoperative complications. During follow-up none developed recurrent obstruction. Our experience demonstrates that laparoscopic adhesiolysis is a valid therapeutic option. Additional experience is needed to determine which types of cases are suitable for the procedure.
Assuntos
Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intestino Delgado , Laparoscopia , Aderências Teciduais/complicações , Aderências Teciduais/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
We describe our experience in 54 consecutive patients who underwent laparoscopic repair of 86 inguinal hernias. Laparoscopic repair of inguinal hernia is technically feasible, does not prolong the length of the procedure nor of hospitalization and is not accompanied by increased morbidity. Although there is not yet general agreement, in our experience and that of others, it appears that laparoscopic repair will be the preferred approach to the treatment of inguinal hernia.
Assuntos
Hérnia Inguinal/cirurgia , Laparoscopia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Splenic metastases are rare and usually occur in the setting of widespread visceral metastases. Splenomegaly as manifestation of metastatic spread is extremely rare. A patient with melanoma and metastases to the skin and lung is described. He developed a giant painful splenomegaly. The splenectomy specimen demonstrated that the spleen was occupied by metastases from the melanoma. Metastases of melanoma may cause extreme enlargement of the spleen. If the patient's general condition is good, splenectomy is indicated in order to prevent spontaneous rupture of the spleen.
Assuntos
Neoplasias Pulmonares/secundário , Melanoma/secundário , Neoplasias Cutâneas/patologia , Neoplasias Esplênicas/secundário , Idoso , Diagnóstico Diferencial , Humanos , Masculino , Esplenectomia , Neoplasias Esplênicas/cirurgia , Esplenomegalia , Tomografia Computadorizada por Raios XRESUMO
Obstructive sleep apnea (OSA) syndrome occurs in 4% to 9% of middle-aged men and in 1% to 2% of middle-aged women. The incidence of OSA among morbidly obese patients is 12- to 30-fold higher. The pathophysiology of OSA is complex and incompletely understood. The important clinical symptoms of OSA include snoring, daytime sleepiness, restless sleep, morning fatigue, and headaches. The diagnosis is made by polysomnography. The possible sequelae of OSA are hypertension, left and right ventricular hypertrophy, sudden cardiovascular death, and increased risk for brain infarction. Nasal continuous positive airway pressure (nCPAP) appears to be the recommended treatment for OSA. Morbidly obese patients may also benefit from weight reduction gastric surgery.
Assuntos
Obesidade Mórbida/complicações , Síndromes da Apneia do Sono/etiologia , Humanos , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/terapiaRESUMO
Staging of gastric carcinoma depends on exact lymph node status. However, very small nodes are not easily found as they are obscured by the surrounding adipose tissue. The purpose of the present study was to demonstrate the usefulness of a Olymph node revealing solutionO (LNRS) in gastric cancer. The perigastric adipose tissue of ten OproblematicO cases of gastric carcinoma, in which <10 lymph nodes were found using the traditional method, was immersed in LNRS for 6-12 h. Subsequently, the lymph nodes stood out as white chalky nodules. They were excised and processed routinely. The traditional method yielded a total of 30 lymph nodes with a mean size of 6.69 +/- 3.43 mm. The LNRS revealed 89 additional nodes with a mean size of 3.03 +/- 3.43 mm, which was significantly smaller. The Node (N) stage was changed in four cases from Nx to N0, in one case from N1 to N2, and in one case from N0 to N2. LNRS seems to be the technique of choice for staging of patients with gastric adenocarcinoma in whom <10 lymph nodes were found with the traditional method and accurate staging was not possible.
Assuntos
Adenocarcinoma/patologia , Fixadores , Linfonodos/patologia , Neoplasias Gástricas/patologia , Adenocarcinoma/classificação , Adenocarcinoma/cirurgia , Humanos , Metástase Linfática , Estadiamento de Neoplasias , Prognóstico , Coloração e Rotulagem , Neoplasias Gástricas/classificação , Neoplasias Gástricas/cirurgiaRESUMO
OBJECTIVE: To investigate the effect of octreotide on wound healing. DESIGN: Experimental studies in vitro and in rats. SETTING: Teaching hospital, Israel. MATERIAL: Cultured human diploid fetal fibroblasts, and 36 male Wistar rats. INTERVENTIONS: Octreotide was added to cultures of fibroblasts in doses of 2, 10, 30, 60 and 120 ng/ml and fibroblasts were counted after 2, 4, and 6 days. Intestinal anastomoses were made in 36 rats. Rats in the octreotide group (n = 18) were given subcutaneous injections of 0.25 microg/kg twice daily and 6 rats were killed at 3, 7, and 14 days. The control group were given injections of saline. Anastomotic bursting pressures and hydroxyproline content were measured at each of the three times. MAIN OUTCOME MEASURES: Fibroblast counts, anastomotic bursting pressures, and hydroxyproline concentrations. RESULTS: Octreotide did not inhibit fibroblast proliferation in any of the doses at any of the time periods. The anastomotic bursting pressure was slightly higher in the octreotide group at each of the time points, but not significantly so, and there was no difference in hydroxyproline content between the octreotide and control groups. Octreotide did not inhibit wound healing either in vitro or in vivo.
Assuntos
Fibroblastos/efeitos dos fármacos , Fármacos Gastrointestinais/administração & dosagem , Intestino Delgado/cirurgia , Octreotida/administração & dosagem , Cicatrização/efeitos dos fármacos , Ferimentos e Lesões/tratamento farmacológico , Análise de Variância , Anastomose Cirúrgica , Animais , Células Cultivadas , Modelos Animais de Doenças , Humanos , Injeções Subcutâneas , Masculino , Distribuição Aleatória , Ratos , Ratos Wistar , Valores de ReferênciaRESUMO
The staging and prognosis of patients with breast cancer is related to the presence or absence of axillary lymph node involvement. However, in some cases no lymph nodes or too small a number of lymph nodes are revealed by the traditional method of palpating and sectioning the axillary fat. In the present study we demonstrate the usefulness of the lymph node revealing solution (LNRS) in breast cancer. Specimens from 13 patients, in whom <10 lymph nodes were identified in the axilla by the traditional method, were included in the study. After excising the lymph nodes by the traditional method, axillary tissue was immersed in LNRS for 6-12 hours. Additional lymph nodes, which stood out as white chalky nodules, were excised and processed as usual. The LNRS increased the mean number of nodes per case from 6.0+/-2.5 found by the traditional method to 12.54+/-4.61 nodes per case (p < 0.01). The size of the nodes identified by the LNRS was significantly smaller (p < 0.01) than those detected by the traditional method. The LNRS changed the lymph node stage of the disease in four of the studied cases (30%). LNRS seems to be the technique of choice for detection of axillary lymph nodes in cases where the number of detected lymph nodes by the traditional method is too small for accurate staging.
Assuntos
Neoplasias da Mama/patologia , Linfonodos/patologia , Fixação de Tecidos/métodos , Axila , Biomarcadores Tumorais/análise , Neoplasias da Mama/química , Fixadores , Humanos , Imuno-Histoquímica , Antígenos Comuns de Leucócito/análise , Linfonodos/química , Mucina-1/análiseRESUMO
Distal gastric resection can be followed by reconstruction according to the Billroth I (BI) or Billroth II (BII) techniques. The aim of this study was to compare the early postoperative results and complications of patients undergoing BI and those undergoing BII resection. Eighty-eight patients operated during the years 1991 to 1994 underwent distal gastric resection (41 had BI, and 43 had BII resections). The indications for BI resections were gastric tumors in 39 patients (95%) and duodenal ulcer in 2 (5%). The indications for BII resection were malignancy in 28 patients (65%) and duodenal ulcer disease in 15 (35%). The average duration of the procedure was 147 +/- 28 minutes for the BI resection and 175 +/- 38 minutes for the BII resection (p < 0.05). No patient in the BI group developed anastomic leakage. Two patients who underwent BII resection developed duodenal stump leakage (4.7%). Relaparotomy was indicated in five patients, two from the BI group (malignant cells in the resection margins) and three from the BII group (one due to duodenal stump leakage and two for bleeding). There was no postoperative mortality in the BI group. The postoperative mortality in the BII group was 7.1% (p < 0.05). The average proximal gastric resection margins were significantly smaller in the BI group than in the BII group (3.65 +/- 2.83 cm and 5.18 +/- 2.57 cm, respectively; p < 0. 05). The number of lymph nodes found in the resected specimen did not differ significantly between the two groups. Recurrent tumor at the gastric remnant developed in two patients in the BI group but not in the BII group. The results of our study revealed that the BI procedure is accompanied by significantly lower postoperative complication and mortality rates than the BII procedure in cases of gastric malignancy. BI resection performed for malignancy seems to achieve smaller proximal gastric resection margins, which may influence the recurrence rate.
Assuntos
Gastrectomia/métodos , Adenocarcinoma/cirurgia , Idoso , Úlcera Duodenal/cirurgia , Feminino , Gastrectomia/mortalidade , Mortalidade Hospitalar , Humanos , Linfoma/cirurgia , Masculino , Recidiva Local de Neoplasia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Neoplasias Gástricas/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVE: To describe the use of a new lymph-node revealing solution (LNRS) for detecting lymph node involvement in total cystectomy specimens from patients with locally confined invasive transitional cell carcinoma (TCC) of the bladder, and to compare the results obtained with those using the conventional method (palpation and sectioning perivesical fat) that may fail to detect very small lymph nodes. MATERIALS AND METHODS: Of 12 cystectomy specimens obtained from patients with TCC, six in which 0-3 metastatic nodes were identified by the conventional method were further investigated using LNRS. The revealing solution comprised 95% ethanol, diethyl ether, glacial acetic acid and buffered formalin (65:20:5:10 v/v) prepared under a fume-hood. After evaluation using the conventional method, the specimens were immersed for 6-12 h in the solution, washed under running tap water and the adipose tissue sectioned at intervals of 2-3 mm. Lymph nodes were identified as white, chalky nodules against the background of yellow fat. The number of the lymph nodes identified by conventional and the LNRS methods was recorded and classified according the TNM system. RESULT: Twenty-two lymph nodes were detected by the conventional method, of which four were positive for tumour metastasis. Using the LNRS, an additional 21 nodes were identified among which 12 were positive. The mean size of the lymph nodes detected by the conventional and LNRS methods was 7.96 mm and 3.81 mm, respectively. The stage of three patients was increased (Nx to N2, N0 to N2 and N1 to N2) and therefore two of these patients received adjuvant chemotherapy. CONCLUSIONS: LNRS significantly enhanced the yield of normal and metastatic nodes of cystectomy specimens and may identify smaller nodes. The LNRS method allows a more accurate staging with better assessment of the prognosis and need for adjuvant therapy.
Assuntos
Carcinoma de Células de Transição , Metástase Linfática/diagnóstico , Soluções , Neoplasias da Bexiga Urinária/patologia , Carcinoma de Células de Transição/secundário , Cistectomia , HumanosRESUMO
PURPOSE: Detection of metastatic lymph nodes in colon cancer is essential for determining stage and, thus, therapeutic modalities. However, very small lymph nodes can easily be missed during routine examination. The aim of this study is to describe a new and easy technique for detecting tiny nodes in colonic specimens. METHODS: Thirty problematic cases, in which an unsatisfactory number of lymph nodes was found by the traditional method, were investigated. The entire mesocolonic fat was immersed for six hours in a lymph node-revealing solution (LNRS) composed of various traditional fixatives and fatty solvents. After six hours, the lymph nodes stood out as white, chalky nodules on the background of yellow fat. They were then excised, processed. and stained. RESULTS: Total number of lymph nodes found by the traditional method in the 30 cases was 88. After LNRS, 258 additional lymph nodes, measuring from 0.5 to 7 mm in largest diameter, were found. Of the 12 cases in which no lymph nodes were found by the traditional method, 8 became N0 and 4 became N1. Of the 14 cases first classified as N0, 4 became N1; of the 4 classified at first as N1, 2 became N2 after LNRS. Upstaging from Dukes B to C occurred in eight cases. Quality of the sections and histochemical and immunohistochemical stains after LNRS was similar to that of formalin-fixed tissues. CONCLUSIONS: LNRS is an easy, rapid, and inexpensive technique for detecting very small lymph nodes. These may contain metastases, a fact that changes the stage of disease and influences the mode of therapy.
Assuntos
Neoplasias Colorretais/cirurgia , Fixadores , Excisão de Linfonodo , Metástase Linfática/patologia , Ácido Acético , Etanol , Éter , Formaldeído , Humanos , Estadiamento de Neoplasias , Estudos Prospectivos , Reprodutibilidade dos TestesRESUMO
Two patients who developed massive bleeding from a gastric pouch ulcer are described. This rare complication occurred during the early postoperative course after silicone ring vertical gastroplasty (SRVG). In both cases the bleeding stopped after the ulcers were injected with epinephrine and alcohol. Both ulcers healed after 1 month of treatment with omeprazole (Losec). The probable etiology of this rare complication is discussed.
Assuntos
Hemorragia Gastrointestinal/terapia , Gastroplastia/efeitos adversos , Hemostase Endoscópica , Úlcera/terapia , Antiulcerosos/uso terapêutico , Epinefrina/uso terapêutico , Etanol/uso terapêutico , Feminino , Humanos , Masculino , Omeprazol/uso terapêutico , Soluções Esclerosantes/uso terapêuticoRESUMO
PURPOSE: In the search for a prognostic discriminant, Ki67 immunoreactivity of colorectal carcinoma was used to see whether this marker correlated with clinical and pathologic parameters and the ultimate prognosis of the patient. METHODS: Fresh specimens from 30 surgically resected adenocarcinomas were obtained and frozen in liquid nitrogen. Slides were immunohistochemically stained with Ki67. Ten randomly chosen fields were examined, and 1,000 nuclei per specimen were counted. The percent positive stained nuclei determined the Ki67 score. Correlation was made with the parameters of Dukes stage, location within the colon, size of malignancy, gender, age, and survival. RESULTS: There was a positive correlation of the Ki67 score for patients with metastatic disease, but no correlation was found to Dukes B and C cases. There was no correlation between Ki67 immunoreactivity and size or location of lesion, patient's age, patient's gender, or whether patient died of disease or developed a recurrence compared with those who survived five years disease-free. CONCLUSION: Ki67 immunoreactivity could not be correlated with clinical and pathologic parameters except for metastatic disease in this study and was of limited use as a prognostic discriminant.